C5: Mismanaged Care: Keys to Succeeding at Medicare Advantage
Wednesday, June 18 | 9:30 AM - 10:30 AM
This program has been submitted (but not yet approved) for Continuing Education for 1.0 total clock hours from NAB/NCERS.
In support of improving patient care, this activity has been planned and implemented by AXIS Medical Education and LeadingAge NJ/DE. AXIS Medical Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
We know the headaches that providers encounter participating in Medicare Advantage plans — constant pursuit of prior authorizations, negotiating contracts, and fighting for payment for services delivered. Medicare Advantage, however, is here to stay and may expand in coming years. Therefore, now is the time to learn and implement the strategies needed to be successful in working with MA plans. Presenters will share lessons they have learned from skilled nursing facilities and home health agencies about how to approach negotiating MA contracts, getting prior authorizations approved and claims paid. This session will also include an update on key national MA policy developments.
Learning Objectives
- Review the federal policy landscape and policies driving Medicare Advantage enrollment and what that means for providers’ financially and operationally
- Explore approaches other providers have adopted that have resulted in improved results when contracting with Medicare Advantage plans
- Review available tools to support providers in their interactions with MA plans
Speaker Information
Vice President, Integrated Services & Managed Care, LeadingAge
Nicole Fallon serves as the Vice President of Integrated Services and Managed Care for LeadingAge, providing strategic leadership on health policy related to aging services, long-term care, Medicare and Medicaid managed care, emerging models of integrated service delivery, and alternative payment models. Fallon shares more than 30 years of health policy experience and expertise on new payment strategies that include managed care for long-term supports and services, programs for dually eligible beneficiaries, accountable care organizations, and bundled and episodic payments. Her expertise provides a valuable resource for LeadingAge member organizations and state partners to understand the changing revenue and system designs, their implications for aging service providers, and provide direction on how to create meaningful, collaborative approaches to address payment, quality, and ‘value-add” of the full spectrum of aging services. Fallon also authored the following white papers while at LeadingAge including, “Integrated Service Delivery: A LeadingAge Vision for America’s Aging Population”(2017), and “Fulfilling the Promise: Medicare Advantage” (2023).
President and CEO, Lutheran Social Ministries of New Jersey
Licensed Nursing Home Administrator/senior care provider for more than 40 years and has provided legal and regulatory guidance to providers as an attorney and as a CEO. Results driven CEO, health care leader, Executive Director, Nursing Home Administrator, Risk Manager and Health Law Attorney with proven record of accomplishment and comprehensive knowledge in operations, acquisitions, partnerships, systems, finance, compliance, quality improvement, risk management, employment, regulatory and legal matters, collaborative leadership, and talent development. Resourceful and creative leader with strong commitment to performance excellence.
VP of Clinical Strategies + Consulting, HealthPro Heritage
Elisa has dedicated over 30 years to the healthcare field, advocating for patients through education and clinical guidance. Holding a Master’s Degree in Occupational Therapy from Tufts University, she has extensive experience in Post-Acute Care, educating interdisciplinary teams, management, operators, owners, and investors. Elisa is a national speaker, delivering programs that provide regulatory and clinical insights to diverse healthcare professionals. She collaborates with Post-Acute providers to implement Medicare, Managed Care, and Medicaid PDPM reimbursement strategies across various care settings while also leading initiatives in Census and Network development. Additionally, Elisa serves as a Subject Matter Expert at Rainmakers Solutions, contributing to two CMS contracts focused on MDS/RAI User’s Manual Support and Maintenance, as well as PAC Training.
